Shouldn't Crohn's Tests Be Done During a Flare-Up?

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I have struggled for years with symptoms of Crohn’s and inflammatory bowel disease. I have been diagnosed with H. pylori and was unable to complete treatment due to a reaction to the antibiotic. I have had endoscopy, bariums, upper gastrointestinal testing and colonoscopies. Lately, I have also developed a severe itching. One of my docs said that I had a “narrow lower esophageal sphincter.” I have just finished a severe flare that lasted five days. All the gastrointestinal tests are usually done when the flare-up is over. For a more definitive diagnosis, shouldn't these tests be done during the flare-up?

A definitive diagnosis of Crohn’s disease or ulcerative colitis is best done when the disease is flaring and the manifestations are readily apparent. However, even when the disease is in remission, there are subtle changes on biopsy specimens that are strongly suggestive of the diagnosis. Also, serologic testing (blood tests) do not change with disease activity.

Itching and a narrowed lower esophageal sphincter are not typical symptoms or findings of inflammatory bowel disease and it would be reasonable for your physician to evaluate you for alternative diagnoses. Problems with the lower esophageal sphincter are quite common and may relate to reflux esophagitis, often referred to as GERD (gastroesophageal reflux disease). This may also be related to your diagnosis of H. pylori.

Last Updated: 7/2/2007

Crohn's disease expert Dr. Bret Lashner is the director of the Center for Inflammatory Bowel Disease at the Cleveland Clinic Foundation.

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